ABSTRACT
The aim of this retrospective cohort study was to determine the frequency and risk factors for cervical spine injury (CSI) in patients with midface fractures. Patients ≥18 years of age entered in the Massachusetts General Hospital Trauma Registry from 2007 to 2017 were identified. Those with a midface fracture, computed tomography and/or magnetic resonance imaging of the cervical spine, and complete medical records were included. There were 23,394 patients in the registry; 3950 (16.9%) had craniomaxillofacial fractures and 1822 (7.8%) had a CSI. Craniomaxillofacial fractures included fractures of the midface (n=2803, 71.0%), mandible (n=873, 22.1%), and midface plus mandible (n=274, 6.9%). The overall frequency of CSI in patients with midface fractures was 11.4% (350/3077). Patients with midface fractures had a higher risk for CSI compared to patients without a midface fracture (odds ratio 2.4, 95% confidence interval 2.1-2.4, P<0.001). In a multivariate model, nasal and orbital fractures, chest injuries, age, injury severity score, and motor vehicle crash or fall as the etiology were independent risk factors for CSI. Mortality was two times higher in subjects with CSI. Early and accurate diagnosis of CSI is a critical factor when planning the treatment of patients with these fractures.
Subject(s)
Fractures, Bone , Neck Injuries , Spinal Injuries , Adolescent , Cervical Vertebrae , Humans , Retrospective StudiesABSTRACT
The influence of the oxide support (i.e., Al2O3, Nb2O5, SiO2, and TiO2,) on the surface properties, reduction and oxidation properties, acid-base properties, and catalytic activity of supported indium oxide catalysts has been investigated by temperature-programmed reduction/oxidation, thermogravimetry coupled to differential scanning calorimetry, ammonia and sulfur dioxide adsorption calorimetry, and reduction of NOx by ethene in highly oxygen-rich atmosphere. Two series of In2O3-containing catalysts at low (approximately 3 wt %) and at theoretical geometric monolayer (from 20 to 40 wt %) In2O3 content were prepared and their properties were compared with unsupported In2O3 material. Supports able to disperse the In2O3 aggregates with high In stabilization gave rise to active catalytic systems. Among the studied oxide supports, Al2O3 and, to a lower extent, TiO2 were found to be the best supports for obtaining active de-NOx catalysts.
ABSTRACT
Intentional trauma has become a significant threat to the health and well-being of all American children. Clinical management of a critically injured child represents a distinctive challenge for the pediatric trauma team. The critical care nurse is an integral part of this team and plays a vital role in the ongoing assessment and management of this unique population. This article presents the patterns of nonaccidental injuries in children and provides strategies for nursing practice in the critical care environment.
Subject(s)
Child Abuse , Critical Care/methods , Pediatric Nursing/methods , Wounds and Injuries/nursing , Child , Humans , Intensive Care Units, Pediatric , Patient Care PlanningABSTRACT
Functional and clinical tests were performed on a group of 36 patients with COPD for 6 years. During this period they had medical treatment as well as cycles of respiratory rehabilitation (diaphragmatic breathing and exercise training). After this period the resistance to muscular work was greatly enhanced in 9 subjects (25%), enhanced in 25 (69%), little enhanced in 2. Functional respiratory parameters did not change in a significant way, thus indicating the stability of the disease, which did not worsen. One interesting feature was the mean reduction in residual volume (-32%, p less than 0.001). This may indicate that a better coordination of the diaphragm can reduce pulmonary hyperinflation. The ventilatory pattern spontaneously changed towards a stability of ventilation, with increased respiratory frequency and reduced tidal volume.
